Cardio 1 Flashcards
What medication is indicated in treating torsades de pointes?
IV Mag Sulfate is used for the treatment of polymorphic VTach assoc with acquired QT prolongation.
** Not used in VF from MI
How would you manage a Pt with VFib vs Afib/Aflutter?
VFib or pulseless VTach should be managed with immediate defibrillation.
In Pt with hemodynamic instability due to Afib, Aflutter, or VT with a pulse should be managed with synchronized cardioversion.
What drug would you use for a patient with intermittent claudication?
Cilosatzol (phosphodiesterase inhibitor) can be used for symptomatic management of a Pt with intermittent claudication.
How does sublingual nitrate provide symptomatic relief in stable angina?
Nitrates cause direct smooth muscle vascular relaxation»_space; systemic venodilation and ^ peripheral venous capacitance. Anti ischemic effect is due to systemic venodilation»_space; decrease in cardiac preload»_space; decrease in end diastolic and end systolic volume»_space; decreased LV systolic wall stress»_space; decreased oxygen demand»_space; improved symptoms.
A holosystolic apical murmur radiating to the axilla would be pathognomonic for …
Mitral Regurg
A 2/6 systolic ejection murmur at R sternal border and LVH would indicate …
Aortic stenosis
In which cases would you use direct current cardioversion vs defibrillation vs transcutaneous pacing?
Defibrillation - provides high energy shock at a random point in the cardiac cycle (unsynchronized shock) and is indicated in patients with V-fib or pulseless V-tach.
DC Cardioversion - energy synchronized to the QRS complex to minimize shock during repolarization (may precipitate V-fib). Should be given to patients with persistent tachyarrhytmia causing hemodynamic instability.
Transcutaneous pacing - symptomatic bradycardia and complete heart block.
What is the MOA of dobutamine in HF?
Dobutamine - adrenergic agonist (predominant activity with B1-AR) and minimal activity of B2 and alpha 1 R. Has positive inotropic and chronotropic effect. Stimulation of B1»_space; ^ cAMP production in cardiac myocytes»_space; ^ Ca2+ mediated binding of actin-myosin to troponin C»_space; ^ myocardial contractility (positive inotropic effect)
Auscultation finding of mitral regurg:
holosystolic murmur at cardiac apex radiating to axilla.
Auscultation findings of mitral stenosis:
diastolic rumble heard at cardiac apex.
Auscultation findings of mitral valve prolapse:
nonejection click with mid-to-late systolic murmur. Due to myxomatous degeneration of mitral valve leaflets
What therapy would you use for a patient in sustained monomorphic V-Tach who are hemodynamically stable?
These patients can be initially managed with antiarrhythmic drugs. IV Amiodarone is the preferred agent. Procainamide, sotalol, and lidocaine are secondaries.
How do you treat paroxysmal supraventricular tach (PSVT)?
carotid massage.
Hemodynamically unstable VTach gets synchronized cardioversion. Vfib and pulseless VT should get defibrillation (unsynchronized shock).
** Digoxin is used for supraventricular arrhythmias (atrial flutter, atrial tach, A-fib) especially in people with HF who aren’t able to tolerate BB or CCB.
What is the MOA of statins in treating hypercholesterolism?
Statins inhibit HMG CoA reductase, which is responsible for converting HMG CoA to mevalonate»_space; decreased hepatic cholesterol formation»_space; activates cell signaling to increase # LDL R on liver cell membranes»_space; ^ removal of circulating LDL
What is a primary side effect of statins?
Statin induced myalgias. Statins can cause proximal symmetric muscle weakness because they decrease CoQ10 synth which is involved in muscle cell energy production.
